With modest resources, the stroke research community has achieved significant breakthroughs, but there is much more to do, says Dr Damian Jenkinson, president of the British Association of Stroke Physicians
Every year there are 152,000 strokes in the UK alone and some 1.2 million people are living with the aftermath of this terrible disease. However, many still do not realise stroke is a preventable and treatable condition.
Treating high blood pressure is the leading controllable risk factor for stroke and is a factor in over half of all strokes. So knowing and managing your blood pressure is a crucial step that can be taken toward conquering your risk of stroke.
There are also more than one million people in the UK who have a condition called atrial fibrillation (AF), a heart condition that causes an irregular heartbeat and allows blood to pool in the heart. This blood can form a clot which can lead to the brain, block an artery and cause large strokes.
AF increases your risk of stroke by up to five times and the chance of you having AF doubles with every decade after the age of 55. Your GP can test your pulse to check for any irregularities and, if deemed necessary, send you for further testing of your heart to determine whether you have AF. Once diagnosed, you can be prescribed anti-coagulant medication to help lower the risk of clots forming in your heart and consequently your stroke risk.
Although symptoms of AF can include palpitations, chest pain, dizziness and light headedness, many cases involve no symptoms at all. Many people only find out they have AF after they’ve had a first stroke.
It’s thought about half of all people with AF in the UK are not receiving necessary anti-coagulation treatment and that through appropriate treatment of AF we could prevent 4,500 strokes a year.
About 85 per cent of strokes are caused by a blood clot blocking an artery in the brain. Our current, most effective way to treat this type of stroke is called thrombolysis. This involves dissolving the clot with clot-busting drugs that are given in the very early minutes and up to four-and-a-half hours after stroke. Thrombolysis significantly reduces the amount of disability a stroke survivor is likely to have from their stroke and helps about one in seven people treated with the medication.
However, there is another procedure on the horizon which may go on to become a standard treatment and which can also be given to patients in addition to thrombolysis. Mechanical clot retrieval, also known as thrombectomy, is a procedure by which the blood clot causing a stroke is pulled out of the brain, typically using a device called a stent retriever that is inserted into the femoral artery at the groin and fed to the site of the clot.
Convincingly, seven recent trials, called MR CLEAN, EXTEND-IA, ESCAPE, SWIFT-PRIME, REVASCAT, THRACE and THERAPY, suggest that clots which block large vessels of the brain can be effectively and safely removed by thrombectomy within the early hours of stroke onset, and lead to significantly reduced levels of disability for those stroke patients treated.
Although it’s still early days, the collective findings provide strong evidence that thrombectomy could one day be included as a routine treatment of stroke patients around the world.
Recent research published in the online medical journal, BMJ Open, shared findings that dementia and stroke are still significantly underfunded in the UK compared with their burden of disease.
The study found that for every £10 spent on health and social care costs in the UK, stroke research received just 19p, and dementia research received only 8p. This was while cancer research received £1.08 and coronary heart disease research received 65p.
Research funding dedicated to stroke in the UK is disproportionately small relative to other major diseases
What people may not know is the underspend into dementia research directly affects stroke survivors too. About one in five cases of dementia in the UK are caused by stroke. Termed vascular dementia, it is the second leading cause of dementia after Alzheimer’s disease and affects about 150,000 people in the UK today. Vascular dementia can be caused by a stroke that blocks a large blood vessel in the brain or by a form of stroke deep in the brain caused by damage to the lining of the blood vessels and known as small vessel disease.
The risk factors for vascular dementia are similar to stroke and coronary heart disease, including high cholesterol, high blood pressure, smoking, obesity and having diabetes. This means there is a tremendous amount that can be done to reduce our risk of both stroke and vascular dementia by adopting a healthier lifestyle.
As many of the same biological disease mechanisms cause both vascular dementia and stroke, the more we learn about one, the more we will learn about the other, and which also makes vascular dementia and stroke are risk factors for each other.
Living with the long-term impact of stroke can be devastating. Yet research funding dedicated to stroke in the UK is disproportionately small relative to other major diseases. With modest resources, the stroke research community has won major breakthroughs in the last 20 years, helping to transform the way stroke is treated. But there is much more to do to conquer stroke. A recent report shows that in 2012, for every cancer patient living in the UK, £241 was spent on cancer research. The comparable spend for each person living with dementia in the UK was £118 spent on dementia research. However, for every person living with stroke in the UK, only £48 was spent on stroke research.